Mastectomy & DIEP FLap: One Year Later

Throughout the day, I have caught myself looking at the clock, wondering what I missed on January 19th one year ago, when I underwent the mastectomy of my right breast and its reconstruction. I am loath to declare the day a “cancerversary,” the cheery-sounding sniglet used by many ensnared within the disease to mark milestones – the day a lump was discovered, a diagnosis delivered, or a surgery undertaken to remove a tumor, a breast, a piece of a lung. Made-up words tend to euphemize and minimize, making us smile when we should be serious.

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I remember attending a talk by one of my favorite authors, Sherman Alexie. I laughed with him and everyone else when he described his father’s beverage of choice as “Squodka” – a mix of Squirt and vodka – belying, I am sure, the anguish a young boy must have known when his alcoholic father disappeared for days at a time. We know alcoholism on the rez is no laughing matter.

Nor is cancer. It is a serious disease deserving of serious words, but we do a spectacularly lousy job of talking about it, throwing made-up words and euphemisms around in ways that trivialize it. “Mastectomy” is code for “amputation.” The latter makes me shudder. Were I an amputee in the “traditional” sense of the word, would I refer to the day I lost a limb as my “ampuversary?” I think not.

Why are euphemisms so acceptable in the cancer conversation? I am not referring to the pink stuff of Breast Cancer Awareness Month, “save the boobies” etc. I am talking about the medical euphemisms, like “lumpectomy” which I used to toss around as though it were akin to the removal of an inconsequential wart, instead of what it really is – a partial amputation. When I was first diagnosed, I thought a lumpectomy was in the cards for me. As a word, it didn’t pack much of a punch. This was before I met my surgeon who pointed out that my cancer was not amenable to lumpectomy given its proximity to the nipple and the fact that I was not endowed with large breasts. Essentially, she didn’t have enough to work with. No, the surgery to remove my breast and reconstruct it would be trickier than the “simple” lumpectomy I had anticipated. In fact, as her meticulous notes would later confirm, “dissection was very difficult given the very small circumareolar incision used for the skin-sparing mastectomy.” It would require additional time and effort, not to mention skill and patience. So she recommended (and I nodded sagely in agreement as though I knew what she was talking about) a skin-sparing mastectomy which entailed removing only the skin of the nipple, areola, and the original biopsy scar to create an opening – a small opening – through which she would remove the breast tissue. Duly spared – spared, no less - the skin would then accomodate a reconstruction using my own tissue. Simple.

Reading through the details of my surgery, you’d never know cancer and its treatment was ugly or that it would hurt. At times it sounds downright regal, befitting a fanfare of trumpets, especially that climactic moment when my breast tissue was “elevated off the pectoralis and delivered from the wound.” While that was happening, my weary husband waited, trying not to be a wreck. It would have been about ten o’clock in the morning when my surgeon came out to announce what she would later write, that “the frozen section was negative for metastatic disease,” that there were no abnormal nodes, that no further dissection would be needed. She had removed all the cancer she could see and could go about her day, leaving me in the very capable hands of two highly sought after plastic surgeons, one being one of the best in Phoenix, the other a master of DIEP flap reconstruction, who had flown in the previous evening from Texas.

They worked on me for the next five hours, and a year later, I look just like myself. You would never know, unless you asked to see, that I really don’t look like myself. Not my original self. Hidden under my clothes, since the DIEP flap reconstruction, is a trivial but nonetheless relocated belly button, its circumference now dotted with tiny white scars. Below it, a thin scar, faded to pinkish-white, stretching from hip to hip, with ‘dog-eared’ reminders on either end where those damned JP drains had pulled excess bloody fluid for days after the surgery. I have a right breast too. Sort of. It is in the shape of a breast, impressively so, now that all the post-surgical swelling and discoloration has gone. Its skin is the same, spared by the mastectomy that removed its cancerous tissue through a very small incision around the areola also removed with its nipple. I tend not to dwell in the macabre, but I cannot help wonder about my old right breast, now a mastectomy specimen preserved in a container of formaldehyde solution. It weighed 294 grams, “the words expressly are ‘a pound of flesh.’” (The Merchant of Venice)

So what did I do to mark the day? I climbed to the top of Piestewa Peak. It has been a couple of years since I sat at the top, surveying the city below. When I reached the summit this sunny afternoon, I wept, glad to be so very high up and far away from where I lay a year ago.

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